Re: Penile duplex pharmaco‐ultrasonography of cavernous arteries in men with erectile dysfunction and generalized atherosclerosis

Abstract

We thank Carlo Foresta and Nicola Caretta for comments on the paper of Bocchio et al. (2006). The comments and criticisms were expected as the clinical use of penile duplex pharmaco-ultrasonography (PDPU) of cavernous arteries has never been fully substantiated due to the lack of reference values of normal healthy men because of its invasive nature, and because of the large variation of Doppler parameters due to easy error sampling and lack of consensus on modalities of sampling and pharmaco-stimulation. Given this general comment I would like to answer to the points raised by Foresta and Caretta: That ‘atherosclerosis hits small vessels earlier that large vessels, hence P-CDU may point out atherosclerotic lesions developed before carotid lesions’, is based on a fascinating hypothesis (Montorsi et al., 2005) to be demonstrated yet. The formula proposed by Caretta et al. (2006) that incorporates peak systolic velocity of cavernous arteries after pharmaco-stimulation and age to predict carotid atherosclerosis is of interest but needs further validation. Intima-media thickening of common carotid arteries is age-dependent also in the absence of atherosclerosis and is accelerated in men exposed to vascular risk factors (Lakatta & Levy, 2003). It is not clear in the population study of Caretta et al. (2006) which is the predictive value of patient age for carotid atherosclerosis and how much the accuracy of the formula is dependent on the inclusion of age. In conclusion, the clinical relevance of PDPU seems to need further validation in the clinical evaluation of men with erectile dysfunction after defining a consensus on modalities of sampling and on reference values of different parameters.